Autism Spectrum Disorder
Autistic disorder (sometimes called
autism or classical ASD) is the most common condition in a group of
developmental disorders known as the autism spectrum disorders (ASDs).
Autistic children have difficulties
with social interaction, display problems with verbal and nonverbal
communication, and exhibit repetitive behaviors or narrow, obsessive interests.
These behaviors can range in impact from mild to disabling. Autism varies
widely in its severity and symptoms and may go unrecognized, especially in
mildly affected children or when more debilitating handicaps mask it.
Scientists aren’t certain what causes autism, but it’s likely that both
genetics and environment play a role.
Types of autism spectrum disorders
The
autism spectrum disorders belong to an “umbrella” category of five
childhood-onset conditions known as pervasive developmental disorders (PDD).
Some autism specialists use the terms pervasive developmental disorder and autism
spectrum disorder interchangeably. However, when most people talk
about the autism spectrum disorders, they are referring to the three
most common PDDs:
- Autism
- Asperger's Syndrome
- Pervasive Developmental
Disorder - Not Otherwise Specified (PDD-NOS)
Childhood
disintegrative disorder and Rett Syndrome are the other pervasive developmental
disorders. Because both are extremely rare genetic diseases, they are usually
considered to be separate medical conditions that don't truly belong on the
autism spectrum.
Signs and
symptoms of autism spectrum disorders
In both children and
adults, the signs and symptoms of the autism spectrum disorders include
problems with social skills, speech and language, and restricted activities and
interests. However, there are enormous differences when it comes to the
severity of the symptoms, their combinations, and the patterns of behavior.
Keep in mind that just because your child has a few autism-like
symptoms, it doesn’t mean he or she has an autism spectrum disorder. The autism spectrum disorders are
diagnosed based on the presence of multiple symptoms that disrupt your child’s
ability to communicate, form relationships, explore, play, and learn.
Social skills
Basic social
interaction can be difficult for children with autism spectrum disorders.
Symptoms may include:
- Unusual
or inappropriate body language, gestures, and facial expressions (e.g.
avoiding eye contact or using facial expressions that don’t match what he
or she is saying)
- Lack
of interest in other people or in sharing interests or achievements (e.g.
showing you a drawing, pointing to a bird)
- Unlikely
to approach others or to pursue social interaction; comes across as aloof
and detached; prefers to be alone
- Difficulty
understanding other people’s feelings, reactions, and nonverbal cues
- Resistance
to being touched
- Difficulty
or failure to make friends with children the same age
Speech and language
Problems with speech
and language comprehension are a telltale sign of the autism spectrum
disorders. Symptoms may include:
- Delay
in learning how to speak (after the age of two) or doesn’t talk at all
- Speaking
in an abnormal tone of voice, or with an odd rhythm or pitch
- Repeating
words or phrases over and over without communicative intent
- Trouble
starting a conversation or keeping it going
- Difficulty
communicating needs or desires
- Doesn’t
understand simple statements or questions
- Taking
what is said too literally, missing humor, irony, and sarcasm
Restricted behavior and play
Children with autism
spectrum disorders are often restricted, rigid, and even obsessive in their
behaviors, activities, and interests. Symptoms may include:
- Repetitive
body movements (hand flapping, rocking, spinning); moving constantly
- Obsessive
attachment to unusual objects (rubber bands, keys, light switches)
- Preoccupation
with a specific topic of interest, often involving numbers or symbols
(maps, license plates, sports statistics)
- A
strong need for sameness, order, and routines (e.g. lines up toys, follows
a rigid schedule). Gets upset by change in their routine or environment.
- Clumsiness,
abnormal posture, or odd ways of moving
- Fascinated
by spinning objects, moving pieces, or parts of toys (e.g. spinning the
wheels on a race car, instead of playing with the whole car)
Diagnosing autism spectrum disorders
In order to
determine whether your child has autism, a related autism spectrum disorder, or
another developmental condition, clinicians look carefully at the way your
child socializes, communicates, and behaves. Diagnosis is based on the patterns
of behavior that are revealed.
If you are concerned
that your child has an autism spectrum disorder and developmental screening
confirms the risk, ask your family doctor or pediatrician to refer you
immediately to an autism specialist or team of specialists for a comprehensive
evaluation. Since the diagnosis of an autism spectrum disorder is complicated,
it is essential that you meet with experts who have training and experience in
this highly specialized area.
The team of specialists involved in diagnosing your child may
include:
- Child psychologists
- Child psychiatrists
- Speech pathologists
- Developmental pediatricians
- Pediatric neurologists
- Audiologists
- Physical therapists
- Special education teachers
Diagnosing an autism
spectrum disorder is not a brief process. There is no single medical test that
can diagnose it definitively; instead, in order to accurately pinpoint your
child's problem, multiple evaluations and tests are necessary.
Getting Evaluated for an Autism
Spectrum Disorder
|
Parent interview – In the first phase of the
diagnostic evaluation, you will give your doctor background information about
your child’s medical, developmental, and behavioral history. If you have been
keeping a journal or taking notes on anything that concerned you, turn over
that information. The doctor will also want to know about your family’s
medical and mental health history.
|
Medical exam – The medical evaluation
includes a general physical, a neurological exam, lab tests, and genetic
testing. Your child will undergo this full screening to determine the cause
of his or her developmental problems and to identify any co-existing
conditions.
|
Hearing test – Since hearing problems can
result in social and language delays, they need to be excluded before an
autism spectrum disorder can be diagnosed. Your child will undergo a formal
audiological assessment where he or she is tested for any hearing
impairments, as well as any other hearing issues or sound sensitivities that
sometimes co-occur with autism.
|
Observation – Developmental specialists
will observe your child in a variety of settings to look for unusual behavior
associated with the autism spectrum disorders. They may watch your child
playing or interacting with other people.
|
Lead screening – Because lead poisoning can cause
autistic-like symptoms, the National Center for Environmental Health
recommends that all children with developmental delays be screened for lead
poisoning.
|
Depending
on your child's & symptoms and their severity, the diagnostic assessment
may also include speech, intelligence, social, sensory processing, and motor
skills testing. These tests can be helpful not only in diagnosing autism, but
also for determining what type of treatment your child needs:
- Speech and language evaluation – A speech pathologist
will evaluate your child's speech and communication abilities for signs of
autism, as well as looking for any indicators of specific language
impairments or disorders.
- Cognitive testing – Your child may be given
a standardized intelligence test or an informal cognitive assessment.
Cognitive testing can help differentiate autism from other disabilities.
- Adaptive functioning assessment – Your child may be
evaluated for their ability to function, problem-solve, and adapt in real
life situations. This may include testing social, nonverbal, and verbal
skills, as well as the ability to perform daily tasks such as dressing and
feeding him or herself.
- Sensory-motor evaluation – Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child's fine motor, gross motor, and sensory processing skills.
Treatment
There is no cure for autism. Therapies and behavioral
interventions are designed to remedy specific symptoms and can bring about
substantial improvement. The ideal treatment plan coordinates therapies
and interventions that meet the specific needs of individual children.
Treatment options include educational/bahavioral interventions,
medications, and other therapies. Most professionals agree that the
earlier the intervention, the better.
Prognosis
For many children, autism symptoms
improve with treatment and with age. Some children with autism grow up to lead
normal or near-normal lives. Children whose language skills regress early in
life, usually before the age of 3, appear to be at risk of developing epilepsy
or seizure-like brain activity. During adolescence, some children with autism
may become depressed or experience behavioral problems. Parents of these
children should be ready to adjust treatment for their child as needed.
People with an ASD usually continue to need services and support as they
get older but many are able to work successfully and live independently or
within a supportive environment.
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